Intravenous Tranexamic Acid Reduces Post-Operative Bleeding and Blood Transfusion in Patients Undergoing Aortic Surgery: A PRISMA-Compliant Systematic Review and Meta-Analysis

Abstract

Background: Tranexamic acid (TXA), an antifibrinolytic agent, has been demonstrated to reduce blood loss and transfusion requirements in both cardiac and non-cardiac surgery. However, the evidence regarding the efficacy of intravenous TXA in aortic surgery has been seldomly analyzed. Therefore, the current study was performed to address this question. Methods: Searches of PubMed, EMBASE, OVID, Cochrane Library and CNKI were conducted comprehensively for randomized controlled trials (RCTs) comparing intravenous TXA versus no-TXA. Independently and in duplicate, we reviewed titles, abstracts and full-text articles, extracted data and evaluated bias risks. A random effect or fixed effect model was utilized to pool data. Results: The database search yielded 4 RCTs involving 273 patients. Meta-analysis revealed that, there was a significant reduction in bleeding volume within the first 4 hours post-operatively [(weighted mean difference (WMD) = –74.33; 95% confidence interval (CI): –133.55 to –15.11; p = 0.01)], and the first 24 hours post-operatively [(WMD = –228.91; 95% CI: –352.60 to –105.23; p = 0.0003)], post-operative red blood cell (RBC) transfusion volume [(WMD = –420.00; 95% CI: –523.86 to –316.14; p < 0.00001)], fresh frozen plasma (FFP) transfusion volume [(WMD = –360.35; 95% CI: –394.80 to –325.89; p < 0.00001)] and platelet concentrate (PC) transfusion volume [(WMD = –1.27; 95% CI: –1.47 to –1.07; p < 0.0001)] following intravenous TXA administration. In addition, intravenous TXA administration significantly decreased the incidence of postoperative complications (53/451 (8.2%) vs. 75/421 (13.9%); odds ratio (OR) = 0.47; 95% CI: 0.30 to 0.75; p = 0.001), according to this present meta-analysis. Conclusions: The current study preliminarily demonstrated that, TXA significantly reduced postoperative bleeding, blood transfusion requirements and postoperative complications among patients undergoing aortic surgery. More well-designed studies are warrant to confirm the efficacy and safety of intravenous TXA in patients undergoing aortic surgery.